Chiropractic medicine is viewed as a form of alternative medicine which teaches that subluxations are the cause of most disease, a view not generally accepted by the medical community.
The use of manipulative therapy--not necessarily chiropractic-- enjoys wide acceptance by medical authorities in many nations. It is covered by many health plans such as Medicare in the United States. Although some medical doctors (MDs) and many doctors of osteopathy (DOs) do perform manipulative therapy, more than 90% of the treatment of back pain by manipulative therapy is performed by DCs (Doctors of Chiropractic). [1]
A survey released in May 2004 by the National Center for Complementary and Alternative Medicine focused on who uses complementary and alternative medicine (CAM), what was used, and why it was used in the United States by adults age 18 years and over during 2002. According to this survey, chiropractic medicine was the fourth most commonly used CAM therapy (7.5%) ([2] table 1 on page 8), excluding all use of prayer. Consistent with previous studies, this study found that a majority of individuals (i.e., 54.9%) used CAM in conjunction with conventional medicine (page 6). "The fact that only 14.8% of adults sought care from a licensed or certified CAM practitioner suggests that most individuals who use CAM self-prescribe and/or self-medicate" (page 6).
Classical chiropractic theory denies otherwise accepted medical facts about the origin of diseases, and instead holds that the correction of subluxation can cure or treat most disease. Manipulative therapy has been shown to have some efficacy in treating back pain, headaches, and other symptoms of spinal-related conditions. Few rigorous studies have supported the efficacy of chiropractic medicine as treatment outside of this specific area. Many people colloquially use the term chiropractic to refer to manipulative therapy of the spine, even by non-DCs.
History
Chiropractic medicine was founded by Daniel D. Palmer of Davenport, Iowa. On September 18, 1895, Palmer was investigating the medical history of a deaf janitor, named Harvey Lillard. Lillard informed Palmer that while working in a cramped area seventeen years ago he felt a pop in his back and had been nearly deaf ever since. Upon examination, Palmer found what he described as a lump that was sore to the touch. He concluded that this lump was a misalignment, which was the possible cause of Lillard's deafness. After correcting this misalignment in the janitor's spine, Lillard's hearing was restored. Lillard was reported to note that he could now hear the wheels of the horse drawn carts in the street below. Palmer began further investigation into the phenomena and believed to have discovered that a major source of interference to the nervous system, the vertebral subluxation, interfered with the body's regulatory mechanism, causing what he termed "dis-ease" or loss of ease.
The term chiropractic literally means "done by hand" and originated when Palmer asked a patient to come up with a name from the Greek language to describe his practice. Of the several names submitted to him, Palmer accepted one which combined the words 'chiros' and 'praktikos' (meaning 'done by hand') to describe his adjustment of a vertebrae in the spinal column. Palmer had been a bee keeper, school teacher, grocery store owner, and had an interest in the metaphysical health philosophies of his day such as magnetic healing, osteopathy, and spiritualism. He imbued the term "subluxation" with a metaphysical and philosophical meaning, holding that subluxations somehow interfered with the body's "innate intelligence", or life force.
Chiropractic medicine has gained general acceptance in the last twenty years as appropriate treatment for back and neck problems. Until 1983 the American Medical Association made it unethical for M.D.'s to refer patients to chiropractors. In September of 1987, the chiropractic profession achieved a victory when Judge Susan Getzendanner found the AMA and others guilty of an illegal conspiracy against the chiropractic profession (Wilke vs. AMA), ordering a permanent injunction against the AMA and forcing them to print the courts findings in the Journal of the American Medical Association. The decision was upheld in the U.S. Court of Appeals in 1990 and again by the U.S. Supreme Court later that same year. The current ethical rules of the American Medical Association now permit M.D.'s to refer patients to D.C.'s for such manipulative therapy if the M.D. believes it is in the best interests of the patients.
A Chiropractor's Education
The educational requirements for chiropractors are similar to that of medical doctors. The Council on Chiropractic Education (CCE) has set minimum guidelines for chiropractic colleges; however, additional requirements may be needed for a license depending on the jurisdiction where a chiropractor chooses to practice . Many states require a four year undergraduate degree, although the minimum prerequisite for enrollment in a chiropractic college set forth by the CCE is ninety semester hours. The minimum cumulative grade point average for a student entering a chiropractic college is 2.50.
Forty-eight of the ninety required semester hours must be completed with the courses as follows:
communication and/or Language skills 6 semester hours
Curriculum for chiropractic college is very intensive and requires slightly more class time than medical school, requiring 2,419 total hours compared to the 2,047 hours a medical student spends in class.
Minimum Required Class Room Hours Chiropractic College / Medical College
Anatomy/Embryology 456 / 215
Physiology 243 / 174
Microbiology 145 /145
Diagnosis 408 / 113
Neurology 149 / 171
X-Ray 271 / 13
Psychology/Psychiatry 56 / 323
Obstetrics & Gynecology 66 / 284
Orthopedics 168 / 2
Chiropractic students require less clinical experience at approximately 1405 hours, whereas their medical counterparts require roughly 5227 hours during their residency.
Two political schools of chiropractic
Contemporary chiropractic is divided into two basic schools: The traditional approach is that followed by the faction of the chiropractive movement known as straight chiropractic[3]. The other school, known as mixing chiropractic, combines contemporary medical techniques with spinal and other joint manipulation. Mixing chiropractic is itself divided into conservative and liberal factions. [4]
The term straight chiropractic is used to denote more strict association with Daniel D. Palmer's chiropractic theory, and of those chiropractic schools who believe that subluxations are the cause of most or all diseases. Outside of treatment (not cure) of a limited set of symptoms associated with the spine, there is no medical evidence supporting the efficacy of straight chiropractic, and some techniques in the past have not been safe.
Reformers who reject classical chiropractic theory
The vast majority of chiropractors do not hold the beliefs professed by Palmer. Great advances in science have been made since the early 1900s, and chiropractic schools are required to teach these subjects in school. Most chiropractic physicians know that bones do not move out of place and they do not press on nerves. We do not have proof of why chiropractic works. There are many theories, as explained in Dr. Robert Leach's book The Chiropractic Theories.
Quotes
"Intelligence is present everywhere in our bodies...our own innate intelligence is far superior to any we can try to substitute from the outside."
--Deepak Chopra
"Get knowledge of the spine, for this is the requisite for many diseases."
--Hippocrates
"Chiropractic, which focuses on manipulating the spine to ease back pain and improve overall health, has won wider acceptance over the years. Most health insurance plans now cover it. But in the 110 years since the profession was created, the established medical community largely has boycotted it — challenging its scientific validity in courts and legislative bodies." --(Washington Times)
"Just as soon as the colored boys found out that a science had been developed for manipulating the bones they all wanted to take it up." --Doctors and Specialists, Morris Fishbein, M.D., Editor of the Journal of the Americal Medical Association and of Hygeia, the Health Magazine; Bobbs-Merrill Company, Publishers, Indianapolis, IN. pp 114-115
"In the Navy we're concerned about health and about preserving health care because we don't get paid by the procedure. We get paid to have Marines and sailors healthy, and that's the same mission as the chiropractic profession..." --Vice Admiral Donald C. Arthur, MD, Surgeon General of the Navy ACANews
References
Pro-chiropractic references
Chiropractic books, like other medical books, are reviewed by Doody Review Services . This review can be accessed by selecting Barnes & Noble after clicking on the ISBN for the book.
Activator Methods Chiropractic Technique, Arlan W. Fuhr (editor), with John R. Green, With Tony S. Keller, Mosby-Year Book, Inc., 1996, hardcover, 460 pages, ISBN 0815136846
Basic and Clinical Anatomy of the Spine, Spinal Cord and ANS, Gregory D. Cramer, Susan A. Darby, Mosby-Year Book, Inc., 1996, hardcover, 441 pages, ISBN 0801664675
Best Practices in Clinical Chiropractic, author: Robert D. Mootz, edited by: Howard T. Vernon, Aspen Publishers, 1999 (or 2001), paperback, 200 pages, ISBN 0834213761, papers from the journal Topics on Clinical Chiropractic
Chiropractic: A Philosophy for Alternative Health Care, Douglass D. Coulter, Science & Technology Books, 1999, paperback 117 pages, ISBN 0750640065
Chiropractic: History and Evolution of a New Profession, Walter I. Wardwell, Mosby-Year Book, Inc., 1992, hardcover, 358 pages, ISBN 0801668832
Chiropractic Management of Spine Related Disorders, Meridel I. Gatterman, Lippincott Williams & Wilkins, 1990 (there may be a new edition), hardcover, 437 pages, ISBN 0683034383
Chiropractic Pediatrics: A Clinical Handbook, Neil J. Davies, Churchill Livingstone, Inc., 2001, hardcover, 475 pages, ISBN 0443062536
Chiropractic Technique: Principles and Procedures, 2nd edition, Bergmann, Thomas F. Bergmann, David H. Peterson, Mosby-Year Book, Inc., 2002 hardcover, 880 pages, ISBN 032302016X
Chiropractic Theories, 3rd edition, Robert A. Leach, with contributions by Charles A. Lantz, and Reed B. Phillips, illustrated by Robert S. Fritzius, Lippincott Williams and Wilkins, 1994, hardcover, 426 pages, ISBN 0683049046
Current Concepts in Vertebrobasilar Complications following Spinal Manipulation, 2nd edition, Allan G. J. Terrett, NCMIC Group, Inc., 2001, paperback, 140 pages, ISBN 1892734036
Differential Diagnosis and Management for the Chiropractor: Protocols and Algorithms, 2nd edition, Thomas A. Souza, Jones & Bartlett Publishers, Inc., 2001, hardcover, 959 pages, ISBN 0834217287
Foundations of Chiropractic: Subluxation, Meridel I. Gatterman, Mosby-Year Book, Inc., 1995, hardcover textbook, 487 pages, ISBN 0815135432
Functional Soft-Tissue Examination and Treatment by Manual Methods: New Perspectives, Revised edition, Warren I. Hammer, Aspen Publishers, Inc., hardcover, 625 pages, ISBN 0834206307
Guidelines for Chiropractic Quality Assurance and Practice Parameters, editors: Scott Haldeman, David Chapman-Smith and Donald M. Petersen, Aspen Publishers, 1992, paperback, 264 pages ISBN 083420388X
Positional Release Techniques (Book for Windows and MacIntosh) with Cdrom, Leon Chaitow, Elsevier Science, 2002, paperback, 350 pages, ISBN 0443070814
Principles and Practices of Chiropractic Techniques, Scott Haldeman, Appleton & Lange, 1992, hardcover, 641 pages, ISBN 0838563600
Rehabilitation of the Spine: A Practitioner's Manual, editor Craig Liebenson, Lippincott Williams & Wilkins, 1996, hardcover, 432 pages, ISBN 068305032X
Text-Book of the Science, Art and Philosophy of Chiropractic For Students and Practitioners, D. D. Palmer, Portland Printing House, 1966 reprint of 1910 edition, hardcover, 1007 pages
Assendelft WJJ, Bouter LM, Knipschild PG. Complications of spinal manipulation - a comprehensive review of the literature. J Fam Pract 1996; 42: 475-480
Beatty, R. "Dissecting hematoma of the internal carotid artery following chiropractic cervical manipulation" J Trauma, 17:248-249, 1977
Benassy, J. and Wolinetz, E., "Quadraplegia after chiropractic manipulation," RHUM, 24:555- 556, 1957
A. Breen, E. Leerberg, M. D Pedigo, G. Waddell, L. G F Giles, E Ernst, and W J J Assendelft Chiropractic for low back pain BMJ, January 23, 1999; 318(7178): 261a - 261.
Chiropractic for low back pain: We don't know whether it does more good than harm, The British Medical Journal, 1998; 317:160-160 (18 July)
Davidson, K., et al, "Traumatic vertebral artery pseudoaneurysm following chiropractic manipulation" NEURORADIOLOGY, 115:651-652, 1975
Ernst E. Chiropractors use of X-rays Br J Radiol
E. Ernst Spinal manipulation: Its safety is uncertain Can. Med. Assoc. J., January 1, 2002; 166(1): 40 - 41
Harrison, J. Strokes ICA Malpractice Alert, 2:1-2, 1981
Krueger, B. and Okazakl, H. "Vertebral-basilar distribuation infarction following chiropractic cervical manipulation", Mayo Clin Pros. 55:322-332, 1980
Levine, J., Howe, J., and Rolofson, J., "Radiation exposure to a phantom patient during simulated chiropractic spinal radiography", Radiol Health Data Reports, 12:245-251, 1971
Miller, R. and Bunon, R. "Stroke following chiropractic manipulation of the spine" JAMA, 229:189-190, 1974
Modde, P. "Malpractice as an inevitable result of chiropractic philosophy and training" Legal Aspects of Med Practice, Feb:20-23, 1979
Rinsky. L, et al, "A cervical spinal cord injury following chiropractic manipulation" Paraplegia, 13:223-22, 1976
Schelihas, K., et al, "Vertebrobasilar injuries following cervical manipulation" Am Med Assoc, 244:1450-1453, 1980
Smith, P and Doll, R., "Mortality among patients with ankylosing spondylitis after a single treatment course with x-rays", Brit Med J, 284:449-460, 1982 Abrams, H., "The overutilization of x-rays", New England J MED, 300:1213-1216, 1979
Stano M, Smith M. Chiropractic and medical costs of low back care. Medical Care 1996; 34: 191-204
Zak, S. and Carmody, R . "Cerebellar infarction from chiropractic neck manipulation" Ariz Med, 41:333-337, 1984
Zauel, D., and Carlow, T., "Internuclear Ophthalmalegia following cervical manipulation" Annals of Neurol, l:308, 1977
Chirobase A skeptical guide to chiropractic history, theories, and current practices, operated by Stephen Barrett, MD; William T. Jarvis , PhD; and Samuel Homola , DC.
